Case Report: Successful Outcome for Refractory Diabetic Peripheral Neuropathy in Patients With Ultrasound-Guided Injection Treatment

Diabetic peripheral neuropathy is the most prevalent chronic complication of diabetes and is based on sensory and autonomic nerve symptoms. Generally, intensive glucose control and nerve nourishment are the main treatments. However, it is difficult to improve the symptoms for some patients; such cases are defined as refractory diabetic peripheral neuropathy (RDPN). In this paper, we present five patients treated with saline and mecobalamin by ultrasound-guided injection. The Visual Analog Scale and Toronto Clinical Scoring System were used to evaluate the symptoms, and the neuro-ultrasound scoring system and electrophysiological severity scale were evaluated by ultrasound and electrophysiological examination. In brief, ultrasound-guided hydrodissection may be a safe way to treat RDPN.

The role of epigenetic mechanisms in the pathogenesis of diabetic nephropathy

Diabetic nephropathy (DN) is a chronic complication of diabetes and the most common cause of the end-stage renal disease (ESRD). Numerous factors have been considered, both contributing to the development of DN, and participating in its pathogenesis. However, to date, the molecular mechanisms, that lead to the development of DN, remain not fully understood. Recently, with the development of high-performance technologies, evidence demonstrating epigenetic mechanisms of regulation of gene expression, including DNA methylation, non-coding RNAs, and histone modifications that play a key role in the pathogenesis of DN through the secondary regulation of genes are starting to appear. All these data can contribute to the creation of new, more effective diagnostic and therapeutic technologies for DN.

Subacute Sclerosing Panencephalitis with Subclinical Infection

Subacute Sclerosing Panencephalitis (SSPE) is a chronic complication of measles. It is a neurodegenerative disorder characterized by cognitive and memory deterioration, behaviour abnormalities, involuntary movements and repetitive myoclonic jerks and a steady motor decline. We report a case of a 7-year-old girl with subacute sclerosing panencephalitis presenting with myoclonic jerks, regression of motor milestones and speech. The child was not immunised for measles. Magnetic resonance imaging revealed multiple variable-sized ill-defined T2W and FLAIR hyperintense areas are seen involving the white matter of the bilateral fronto-parietal lobes. Electroencephalograph findings and CSF analysis confirmed the diagnosis of subacute sclerosing panencephalitis.

Komplikasi Kronik Benda Asing Pada Percabangan Bronkus

CHRONIC COMPLICATION OF FOREIGN BODY IN TRACHEOBRONCHIAL TREE : A CASE REPORT Foreign body aspiration in tracheobronchial could be life threatening particularly if the object large enought to cause nearly complete obstruction. In the other hand small object could pass beyond carina and cause less severe sign and complication manifest. Chronic symptoms with recurrent infection that lead to brochiectasis may occur in delayed of extraction. We presented a case of nail aspiration by a 17 years old male patients who presented with hemoptysis. The patient had history of nail aspiration six months ago and had no symptom until the last one week . First attempt of evacuating used rigid bronchoscopy under general anesthesia had failed. Fiber optic bronchoscopy (FOB) found the nail at the orificium of right lower lobe and chest computed tomography stated the occurancy of bronchiectasis at distal of nail. The extraction was performed by FOB with local anesthesia succeeded to remove the nail to the laring that induced cough and nail threw out. There were no major complication and further symptoms after the extraction. Eventhough aspiration small object cause no symptom, it could lead to chronic complication such as bronchiectasis. FOB for removing the object is supposed to perform carefully because the object could fall on another part of brochial tree when it was pulled out. Keywords Foreign Body, Bronchial tree, complication, flexible bronchoscopy

Computed tomography findings at 6th month related to chronic anastomotic complications after rectal surgeryShort running headline: CT findings related to chronic complication

Objective: This study aimed to assess a radiologic test and clinical findings as risk factors of chronic complications after anastomotic leakage (CCAL) in rectal surgery.Summary of Background Data: Anastomotic leakage (AL) is the most important complication that is related to chronic complications like unhealed chronic sinuses, strictures, and infections.Methods: This retrospective study included patients who developed anastomotic leakage (AL) after undergoing extraperitoneal anastomosis. Patients with the following characteristics were excluded: (1) patients with no anastomoses, (2) patients undergoing multiple resections due to synchronous colorectal lesions, (3) patients with no curative resections of the primary lesions, and (4) patients experiencing immediate postoperative mortality. Finally, 72 patients were analyzed in this study. The patients were divided into the no chronic complication (NCC) group and the chronic complication (CC) group.Results: Of the 72 included patients, 17 (23.6%) had CCAL. The patients in the CC group more frequently had radiotherapy and lower tumor compared to the patients in the NCC group. A total of 52 (52/55 [94.5%]) and 4 patients (4/17 [23.5%]) in the NCC group and the CC group achieved bowel continuity 3 years after the primary surgery, respectively (p < 0.0001). According to the multivariate analysis, CT findings at the 6th postoperative month and tumor height were associated with CCAL (p < 0.0001 and p = 0.046, respectively).Conclusion: This study showed that CT findings at the 6th postoperative month and tumor height were possibly associated with CCAL.

Diagnosis and rational treatment of painful diabetic peripheral neuropathy: an interdisciplinary expert consensus

Diabetic peripheral neuropathy is a common chronic complication of diabetes mellitus, significantly impairing well-being, quality of life and functioning of patients. The prevalence of diabetic peripheral neuropathy in the Russian Federation ranges from 0.1% to 67.2% in type 1 and from 0.1 to 42.4% in type 2 diabetes mellitus. However, based on the large-scale epidemiological studies, the true prevalence of diabetic peripheral neuropathy is much higher (50 to 70%), with its painful variant occurring in 16% to 30% of patients. Despite the fact that diabetic peripheral neuropathy remains the most common chronic complication of diabetes mellitus, its diagnosis and therapy leave much to be desired. To optimize diagnostic and treatment approaches to painful diabetic peripheral neuropathy, a group of experts representing the leading Russian professional medical associations has developed clinical guidelines for the diagnosis and rational therapy of patients with painful diabetic peripheral neuropathy. This document presents practical aspects of the clinical diagnosis of painful diabetic peripheral neuropathy and an algorithm for differential diagnosis of pain in the lower extremities in patients with diabetes mellitus. The use of symptomatic analgesics with central action, such as anticonvulsants, antidepressants and opioids, is based on the main aspects of neuropathic pain pathophysiology. The characteristics of each drug class are given, with consideration of evidence on their efficacy, tolerability, and the possibility of combination therapy. The data on the first, second, and third lines of agents is presented in accordance with several international clinical guidelines. The need for a tailored drug choice, taking into account the evidence-based data on their efficacy and safety, concomitant drug therapy, tolerability, cost and preferences of the patient, age of the patient and concomitant disorders, is emphasized.

Diabetic polyneuropathy: a current algorithm for patient management

Diabetic polyneuropathy (DPN) is the most common chronic complication of diabetes mellitus and can develop just at the prediabetes stage. As DPN progresses and, in the absence of its adequate treatment, leads to worse quality of life and its shorter expectancy in patients. The paper discusses current clinical guidelines for the examination and management of patients with DPN, diagnostic methods, and pathogenetic treatment of this disease.